Containment or suppression of hostile Le continimento o suppression de imimpulses emerges as a sensible syn-pulsos de hostilitate se revela como un thesis of the known psychosocial factors synthese plausibile del cognoscite facin rheumatoid arthritis. An unusual case tores psycho-social in arthritis rheumaprovides a n opportunity to present a toide. Un caso inusual provide le opporreview of the literature. This is an tunitate de presentar un revista del important area for further research. litteratura. Isto es un importante area pro recercas additional.OR THE LAST hundred years the literature on rheumatoid arthritis F has presented occasional references to the importance of psychologic and social factors. The frequency of such reports is growing geometrically and a sample of American rheumatologists recently queried about the most important areas for research on this disease consistently indicated that the psychosocial area should get primary a t t e n t i~n .~~ Many interesting aspects of this problem were pointed out by King,la in his review of the literature. However, to date the known facts have not been marshalled in such a meaningful array that one could say that there is one dominant influence in this disease. In the course of studying the case here presented, a possible synthesis around a central concept of contained hostility became apparent. Therefore, this case is presented with a review of the pertinent literature. Following the example of Nemiah,27 the patient was selected for study because he suffered from two interesting diseases,27 rheumatoid arthritis and duodenal ulcer, and because of his intelligence, his powers of observation and his willingness and ability to communicate. The relationship established between the patient and the investigator was purely for research purposes. At no time did the investigator assume any therapeutic responsibility for the patient beyond friendly concern and occasional simple advice. CASE HISTORYDr. A. is a scientist in his early fifties, who was born the youngest of four sons in a small country town where his father was the minister. His mother was a vigorous woman, who before her marriage had been a school teacher, and who, at the age of 91, was still said to have more energy than any of her sons. The older two siblings, aged 66 and 64, are teaching school. The third boy, now aged 61, is, like the patient, a scientist, and it is interesting to note that he also had a peptic ulcer which ultimately led to gastrectomy. The only rheumatism reported in his family was in his father. This appears to have come on in the seventies and to have been mild, certainly never disabling.A. is nine years younger than his next older sibling. He repeatedly identifies himself as being like his mother and her side of the family. His father is conspicuous by the fact that he was never mentioned in the interviews beyond being identified as the Presbyterian

The hypothesis of suppressed hostility as a factor in rheumatoid arthritis is supported by the finding that rheumatoid arthritics are more liable to divorce, but put up with an unsatisfactory marriage longer than those who are free of the disease. This is more striking for males than for females.Le hypothese de supprimite hostilitate como factor in arthritis rheumatoide es supportate per le constatation que patientes de arthritis rheumatoide ha un augmentate incidentia de divorcios sed indura un dissatisfacente maritage plus longemente que subjectos sin ille morbo. Iste relation es plus marcate in mascu10s que in femininas.ARITAL STATUS is an easily measurable aspect of the social environ-

No abstract

Relationship-centred communication is considered a desirable goal in veterinary medicine, and a number of different tools have been developed to measure relationship-centred communication. This study was designed as an initial assessment of an adapted version of the Verona Patient-centred Communication Evaluation (VR-COPE) scale, originally developed for medical communication research, to evaluate its potential for measuring relationship-centredness in veterinary consultations. Fifty-five consultations in the United Kingdom and United States of America were videotaped and analysed. The median VR-COPE total score (out of a potential 100 points) was 76.00 for all consultations. The highest overall score was for "Structuring" (of the consultation), whereas the lowest scores were for "Client Worries," "Psychological Impact," and "Empathy." This initial assessment of the adapted VR-COPE suggests it may be helpful in measuring content, process, and structuring skills related to relationship-centredness in veterinary consultations. It may also help uncover aspects of relationship-centredness that are unique from those uncovered by other tools. Further research is needed to fully assess the role of VR-COPE in veterinary communication research and the contributions it can make to relationship-centredness in veterinary consultations.

which also required a loose screw be removed 5 weeks post operatively. 2 cases required implants to be removed due to migration, one of these also had a recurrence of lameness caused by a broken implant 8 months post operatively which was successfully managed conservatively. No cases were reported to later require pantarsal arthrodesis. CONCLUSIONS Articular fractures of the talus are occasionally seen in practice and may prove a diagnostic challenge due to their varied presentations and radiographic superimposition of structures. Pathology of the talus may be suspected in any case of lameness localised to the hock and oblique/skyline radiographic views or advanced imaging should be considered. Short term follow up of all cases demonstrated good healing of the fracture site and fibular osteotomy, where applicable. Intra-and inter-observer reliability and repeatability of computed tomographic changes affecting the medial coronoid process in the canine elbow